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Eurasian heart journal

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No 1 (2017)
3-8 445
Abstract
The Guidelines are designed to demonstrate possible approaches to routing patients with hereditary atherogenic lipid disorders in accordance with existing legal documents. The Guidelines define the stages of medical care of this group of patients. For each stage the possible types of medical care, conditions of its provision and hospitals, on the basis of which it can be provided, as well as ways of payment are established. Criteria for the detailed examination of patients with suspected hereditary atherogenic lipid metabolism are shown. Recommendations reassigned for health care managers, chief-hospital physicians, cardiologists, internists and other physicians.

ORIGINAL PAPERS

10-14 563
Abstract

Objective. The questions of female health last years get the increasing urgency cardiovascular disease occupy a leading place in structure смертности from the women in the different countries. Often risk of development cardiovascular disease at the women is underestimated, mainly because their first displays at the women develop approximately for 10 years later, than at the men. However given Fremingem of research testify to that that, despite of smaller frequency ишемической of coronary heart disease (CHD) at the women, mortality at them is higher, than at the men.

Aim. To study features of development and current acute coronary syndrome and acute myocardial infarction at the women in various age groups in one of areas of. Tashkents (on the data of the register). Methods. 219 women, which average age = 59,48±7,51 years were switched on in research. The data received in past research" The Register acute coronary syndrome and a acute myocardial infarction in one of areas of were analyzed. Tashkents " for 2009 -2010 years. The preventive, statistical, mathematical methods of research were used.

Results. The results of our research have shown, that asymptomatic the debut of disease was marked in 1 (0,7%) case the isolated pain in thoracal to a crate was fixed at 3 (2,1%) пациенток, the combination of this symptom with dyspnea met at 7 (4,9%), weakness - at 20 (13,9%), and with cold then - at 1 (0,7%) patient. The presence dyspnea, in a combination to weakness was registered at 10 (6,9%), and dyspnea with cold then - at 2 (1,4%) patients. The weakness as the isolated symptom met at 2 (1,4%) patients. A combination of four symptoms: pain in a breast, dyspnea, weakness and cold sweat were registered at 16 (11,1%) patients. Pain, dyspnea, syncope and cold sweat marked 1 (0,7%) woman.

Conclusion.The results of our research have shown, that in process of increase of age at the women the growth acute coronary of pathologies is observed. Most often ACS/AMI develops at the women in age group 60-64 and 65-69 years. The analysis on risk factor (RF) as a whole on group has shown, that most widespread from them were AH and superfluous weight of a body. At the young women conducting risk factors have appeared smoking and obesity. With age the role such a RF, as AH, diabetes mellitus (DM) and hypercholesterolemia is increased. The low adherence to treatment and low level of knowledge is shown concerning acute coronary of a pathology.

16-23 562
Abstract

Aim. To define principles of coronary wire choice during coronary artery chronic total occlusion (CTO) recanalization by antegrade approach.

Material and methods. From 2009 to 2013 the attempt of coronary artery CTO recanalization by antegrade approach was undertaken for 217 patients. Depending on success of CTO crossing by coronary wire patients were divided into 2 groups: group 1 (n=164) - successful wire crossing, group 2 (n=53) -unsuccessful attempt of CTO recanalization by coronary wire.

Results. In the group 2 there were more frequent CTO localization in the right coronary artery (p<0,05 as compared to group 1), presence of blunt stump, higher frequency of side branches in the zone of proximal CTO cup, and large CTO length (p<0,001 as compared to group 1). CTO recanalization in 47% cases begun from soft wire with polymeric coating and tapered tip, successful recanalization by these wire type was achieved in 49,02% patients. Using non-tapered tip intermediate stiffness wire as the first choice wire was associated with the failure of recanalization (p=0,0440 in intergroup comparison). At impossibility of CTO recanalization by soft wire with polymeric coating and tapered tip used as a first choice, it replacement on non-tapered tip intermediate stiffness wire allowed to achieve successful recanalization in 36,67% patients. In the cases of this strategy uneffectiveness using stiff wire with polymeric coating and tapered tip as a third choice allowed additionally to attain successful recanalization in 60% cases. Replacement of the soft wire with polymeric coating and tapered tip on stiff wire with polymeric coating and tapered tip, executable at presence of meaningful rigidity in the proximal CTO cup zone associated with the achievement the successful recanalization in 60% cases.

Conclusion. On the basis of the obtained data it was created the conception of step-up wire stiffness increase during the CTO recanalization by antegrade approach.

24-31 373
Abstract

Background. It is well-known that in majority of cases treatment with statins can be safe and well tolerated, but in some patients observed statin-induced adverse liver or muscle symptoms - the main reasons for statin discontinuation. Asian ethnicity - is one of the predisposing factors for statin-associated adverse effects.

Objective. To study possible effects of CYP3A5 (6986A>G), CYP2C9 (430C>T), CYP2C9 (1075A>C), SLCO1B1 (521T>C) and BCRP (ABCG2, 421C>A) genetic polymorphism on simvastatin tolerance and safety in ethnic Uzbek patients with Coronary Artery Disease (CAD).

Material and methods. The prospective case-control research included 100 patients with CAD. Group "case" were 50 patients who demonstrated statin-induced adverse liver effects (transaminase level increases 3 times and more - in 37 cases) or statin-induced elevations in serum CK (of >3*UNL - in 4 cases) at treatment with simvastatin with the dose of 20 mg/day for 3 months of treatment and 13 with myopathy, associated with increased levels of total creatine phosphokinase (CPK) 3 times or more. In 4 patients with adverse effects on the liver, along with an increase in the enzymes, while there was an increase of CPK levels. Control group contained 50 patient with CAD treated with simvastatin with the dose of 20-40 mg/day for one year without side effects. The both groups of patients were similar in gender, age, original index of kidney function and serum CK level. The comparison group consisted of healthy ethnic Uzbeks (n = 41) of comparable age and sex, with the absence of a family history of coronary artery disease. The research was performed by means of PCR-RFLP method.

Results. As a whole, all genotypes (except for CYP2C9 * 2 in patients) were in Hardy-Weinberg equilibrium. Among patients with simvastatin intolerance, compared to the control group, the following genotypes were observed more frequently with high level of confidence: CYP3A5 *3/*3, compared to genotype variants *1/*3 and *1/*1 (OR 9.33; 95% CI 3,37-25,9; P = 0.0001) and BCRP CA (patients with BCRP CC genotype were not observed among those examined) (OR 3.22; 95% CI 1,258,30, P = 0.024).

Conclusions. Genotypes CYP3A5 *3/*3 (6986A>G) and BCRP CA (ABCG2, 421C>A) are accompanied with the increase of statin-induced adverse effects in ethnic Uzbek patients with Coronary artery disease.

32-43 2793
Abstract

Aim: to study the efficacy of sildenafil therapy in pulmonary hypertension of different etiology, its influence on the clinical, functional, hemodynamic status, structure and function of the right and left heart, right ventricular-arterial coupling (RVAC) in pts with idiopathic pulmonary hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

Materials and methods: in the study we included 29 IPAH pts aged 42.8±10.6 yrs, 28 CTEPH pts aged 43.4±10.4 yrs II-IV functional class (FC) (WHO), receiving stable standard therapy (anticoagulants, diuretics, glycosides) and calcium channel blockers for at least 3 months. Sildenafil was started at the dose of 10 mg TID to assess the tolerability for further titration after 1 wk to 20 mg 3 times a day. The treatment duration was 16 wks. At baseline and at wk 16 FC (WHO), 6-minute walking test (6-MWT), transthoracic echocardiography (Echo) and right heart catheterization (RHC) were performed.

Results: both groups were comparable in baseline functional parameters: FC, the distance in 6-MWT, Borg index. The analysis of baseline structural and functional cardiac parameters by Echo in IPAH and CTEPH pts revealed pronounced cardiac remodeling as compared to the control group. All pts had criteria precapillary PH by RHC with comparable systolic pulmonary artery pressure (SPAP), mean pulmonary artery pressure (PAPm), cardiac output (CO) and index (CI), pulmonary vascular resistance (PVR) except for diastolic PAP (DPAP), which was higher in IPAH group (38.3±13.7 mm Hg vs 31.5±8.9 mm Hg in CTEPH group (p<0.05). Sildenafil therapy resulted in the marked improvement of functional and hemodynamic status, cardiac remodeling parameters in both groups. To wk 16 IPAH pts achieved the 114m increase in 6-MWT as compared with 108m in CTEPH group. IPAH pts demonstrated the significant decrease in SPAP, PAPm, reduce of right ventricular (RV) size and improvement of contractile function - FAC and TAPSE, increase of RVAC by reducing LV stiffness. Eccentricity index of LV improved significantly only in CTEPH pts. Positive dynamic in RHC data (significant decrease of SPAP, PAPm, DPAP, PVR, increase of CO,CI, stroke volume). CTEPH pts showed a greater reduction in PVR, SPAP and significant SvO2 improvement.

Conclusion: 1. In pts with IPAH and CTEPH of comparable baseline clinical, functional and hemodynamic status we found no significant differences in the severity of cardiac remodeling, RV and LV systolic and diastolic function. Regardless of etiology RVAC was reduced due to the significant increase of LV stiffnessEs. 2. 16-wk sildenafil therapy in pts with IPAH and CTEPH resulted in the positive dynamic of 6-MWT distance, dyspnea index, Echo data including LV stiffness. 3. In CTEPH group as compared with IPAH pts we found the more marked reduction in PVR, PASP and significant improvement SvO2 by RHC. The significant decrease in Es was observed only in CTEPH pts.

44-48 518
Abstract

Aim: Studying of outcomes of stable angina during five years' prospective study according to the Register of an acute coronary syndrome and an acute myocardial infarction (ACS/AMI) with an assessment of the prognostic importance of risk factors and medical history data on mortality.

Material and Methods: In this paper we studied the results of 5-year prospective study of 196 patients suffering from stable angina, with the assessment of the impact of risk factors and medical history data on mortality from stable angina according to register ACS / AMI.

Results. The most common risk factor for CHD among hospitalized patients with stable angina, hypertension was (80.6%) and GC (39.3%). Prior to admission in more than % patients had angina before, more than 2/5 suffered MI earlier, there were У signs of CHF, У suffered from diabetes. During the period of the five-year prospective study of 196 patients with stable angina in 54 patients (29.6%) developed acute myocardial infarction and of which 24% was observed in death. Five-year mortality in patients with stable angina - 23.5%, with the main cause of death (63%) were acute heart failure. For 5 years of prospective study, the presence of heart failure and diabetes, and patients with a history of myocardial infarction is associated with a poor prognosis for mortality with stable angina.

REVIEW

50-56 334
Abstract
The review describes current possibilities of nuclear imaging methods in different types of pulmonary hypertension (PH): lung ventilation-perfusion scintigraphy and single photon emission computed tomography (SPECT), radionuclide ventriculography and angiography, as well as new potentials of myocardial perfusion SPECT for the evaluation of right ventricle.

CLINICAL CASE

57-60 458
Abstract
The article deals with a rare clinical case of chronic thromboembolic pulmonary hypertension in children. This case demonstrates the difficulty of identifying of chronic thromboembolic pulmonary hypertension and masking it under the community-acquired pneumonia. In the diagnosis of the leading methods were echocardiography of the heart and radiopaque tomography of the chest. Etiology of the disease has been established. The use of anticoagulants in the treatment led to positive dynamics: to re radiopaque tomography of the chest imaging of blood clots is not more than 1 mm, decrease in pulmonary artery pressure.

ANNIVERSARIES



ISSN 2225-1685 (Print)
ISSN 2305-0748 (Online)